Lung transplantation for acute respiratory distress syndrome

Lung transplantation (LTx) is a well-established therapy for patients with chronic lung failure, including interstitial lung disease, chronic obstructive pulmonary disease, cystic fibrosis, or pulmonary vascular disease. Excellent long-term survival can be achieved, making LTx a mainstay in the therapy of patients with these indications. In contrast to chronic lung diseases, the role of LTx in acute lung fail-ure is less established. Although acute respiratory distress syndrome (ARDS) is listed as an acceptable indication by most published guidelines, there is a great variance of this practice. In general, reported numbers are low and available evidence is almost exclusively limited to case reports or small case series. With the rapid evolving SARS-CoV-2 pandemic, and an increasing number of unweanable post- COVID-19 ARDS patients receiving extracorporeal mem-brane oxygenation (ECMO), many LTx centers started to evaluate this practice. This work aims to summarize the currently available literature on LTx for ARDS, report out-comes of the practice of LTx for ARDS, provide guidelines of LTx for ARDS, and discuss selection criteria beyond published evidence.